MEDICARE: KEN MARK TASHIRO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083A0100X	Aerospace Medicine Physician	60631	TN
2	2083X0100X	Occupational Medicine Physician	60631	TN
3	207Q00000X	Family Medicine Physician	60631	TN

General Provider Information

NPI Number	:	1194874578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEN MARK TASHIRO MD

Provider Business Mailing Address
First Line	:	PO BOX 2008
Second Line	:	4500N MS 6220
City	:	OAK RIDGE
State	:	TN
Zip	:	37831-2008
Country	:	US
Telephone Number	:	865-574-7431
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BETHEL VALLEY RD BLDG 4500N
Second Line	:	MS 6220
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-8050
Country	:	US
Telephone Number	:	865-574-7431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	02/05/2026

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